Advances in Treating Treatment-Resistant Depression (TRD)

A specialist in treating treatment-resistant depression offers effective treatment strategies for doctors to try and assist with TRD.

Progress in Treating Tough Depression (TRD)

By Dr. Gonzalo Laje, MD, as told to Kara Mayer Robinson

I’m a psychiatrist, board-certified in child, adolescent, and adult psychiatry. After battling my own depression in my 20s, I’ve made it my mission to understand and help others struggling with mental health. With almost a decade of experience at the National Institutes of Health researching depression treatments, I now manage Washington Behavioral Medicine Associates in Chevy Chase, MD, where we specialize in treating patients of all ages with treatment-resistant depression, or TRD. Let’s dive into the important details about TRD and the exciting advances in its treatment.

🤔 How do you know it’s TRD?

Most experts would agree that treatment-resistant depression is diagnosed when two or more antidepressants, taken at maximum dose for at least 6 weeks each, have proven ineffective. It’s crucial to explore alternative treatment options when traditional antidepressants fail to provide relief.

💡 What can you do if you have TRD?

Successfully treating TRD requires a multifaceted approach. It’s not a one-size-fits-all solution, but rest assured, there are numerous possibilities to explore. My approach involves tackling depression from various angles, encompassing:

  1. Dietary changes: Improving your mental health may start by nourishing your body with foods that promote well-being.
  2. Exercise: Engaging in physical activity releases endorphins and helps alleviate depressive symptoms.
  3. Medical evaluation with comprehensive bloodwork: Identifying any underlying medical conditions or deficiencies is essential for effective treatment.
  4. Medication: Exploring alternative antidepressants or combinations of medications can yield positive results.
  5. Neuromodulation: Employing techniques that stimulate or inhibit brain activity, such as electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS), shows promise in treating TRD.
  6. Psychotherapy: Seeking talk therapy strategies that focus on the present can aid in problem-solving, emotional recognition, and promoting a healthy mind-body connection.
  7. Restorative sleep: Establishing healthy sleep habits can have a significant impact on mental well-being.
  8. Supplements and vitamins: Addressing potential deficiencies by incorporating supplements that support mood improvement.

A comprehensive approach like this allows us to understand your medication history, explore underlying medical factors, and find the right combination of treatments to harmonize your brain function.

🌟 Which treatments are best for TRD?

Over the past 15 years, significant progress has been made in evidence-based strategies for TRD. Researchers have identified medications and techniques involving brain stimulation or inhibition, known as neuromodulation, as promising options.

  • Medication: Beyond traditional selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), medications like tricyclic antidepressants, lithium, thyroid hormone, and monoamine oxidase inhibitors (MAOIs) have shown success. Furthermore, ketamine, once known as a mere anesthetic, has emerged as a remarkable aid in severe TRD cases, offering rapid relief in a matter of hours.
  • Neuromodulation: Electroconvulsive therapy (ECT), a well-established but often misunderstood treatment option, can safely and effectively alter brain chemistry to reverse depressive symptoms. Meanwhile, repetitive transcranial magnetic stimulation (rTMS) pairs well with other treatment strategies due to its positive results and minimal side effects.

The combination of medication and neuromodulation offers hope to individuals who have previously struggled to find relief from TRD.

🤔 What other treatments might doctors try for TRD?

Although still being researched, several alternative treatments show potential in helping individuals with TRD:

  • Light therapy: Particularly effective for those with seasonal depression, light therapy involves exposure to bright light, either through lightboxes or goggles, to alleviate symptoms and improve sleep.
  • Psilocybin: Also known as “mushrooms,” this psychedelic compound has been studied as a possible depression treatment, showcasing fewer side effects compared to traditional antidepressants. While more research is needed, it could be an option for individuals who haven’t found success with other treatments.
  • Nitrous oxide (N2O): Commonly referred to as “laughing gas,” N2O has shown promise in rapidly relieving depressive symptoms, similar to ketamine. However, further research is still necessary to establish clear protocols for N2O usage in depression treatment.

These alternative treatments present hope for those who have exhausted conventional options and are looking for new possibilities.

😊 Does psychotherapy help TRD?

Psychotherapy plays a vital role in the treatment of TRD. Talk therapy strategies that emphasize problem-solving, understanding emotional barriers, promoting a healthy mind-body connection, and facilitating the recognition and management of emotions have proven highly effective. Different types of therapy may be more suitable based on individual circumstances, with some therapies aligning better with specific challenges.

🚩 What are common challenges in treating TRD?

Diagnosing TRD accurately poses an initial challenge. Understanding other co-occurring conditions, such as anxiety, obsessive-compulsive disorder, personality disorders, or other medical issues, is crucial for finding the most effective treatment. Additionally, since predicting the best strategy for each individual remains challenging, treatment often involves trial and error, which can lead to anxiety and frustration.

🚀 What can you do to improve your chances of finding a treatment that works?

Collaborate closely with your primary care provider and therapist to explore different strategies. Consulting an experienced psychiatrist or psychopharmacologist can also provide valuable insights. Remember, there are numerous treatment options available. Some individuals may feel disheartened after exhausting multiple options, but depression is an illness that can be managed. If your current treatment seems ineffective, don’t hesitate to discuss alternative strategies with your healthcare provider.

🌐 References:Science Translational Medicine: “A phase 2 trial of inhaled nitrous oxide for treatment-resistant major depression”Mayo Clinic: “Treatment-resistant depression.”

Let’s continue the conversation on treating TRD and share this article with others who may benefit. Together, we can bring hope and support to those in need. 🌟